Ethanol Induced Thyroiditis Ablated the Thyroid Cyst: A Complication with a Happy Ending
TO DESCRIBE A DELAYED TRANSIENT COMPLICATION FROM PERCUTANEOUS ETHANOL injection, PEI of painful thyroiditis, during the successful therapy of a large complex symptomatic thyroid cyst.
PEI IS A SAFE ALTERNATIVE TO SURGERY IN RECURRENT BIOPSY PROVEN BENIGN COMPLEX THYROID CYSTS. Side effects are minimal, including transient pain on needle withdrawal, rarely severe pain if the needle comes out of the cyst, and transient voice changes If the needle is near the recurrent nerve. Complications are rare, but PEI is very operator dependent. This is the first report of painful thyroiditis after PEI.
42 y/o F with enlarging mass in her neck which she could see in the mirror. She claims it came from unicycle accident with severe neck trauma at age 10. Local symptoms include difficulty swallowing and she claims it is “ugly”. There is new family history data of benign large nodular goiters requiring surgery. PE: Euthyroid, with a large thyroid mass on the right lobe, and smaller enlargement on the left.
PEI THYROID EVALUATION
FT4 ,TSH, TG, TPO, TG-AB, CALCITONIN ALL NORMAL. THE TSH WAS 1.7 N ( 0.3-3.0 ) DX ULTRASOUND: LARGE COMPLEX CYST 8.1 ml 3.5 cm WITH DOPPLER BLOOD FLOW IN THE SOLID COMPONENTS. USGFNA: BENIGN THYROID COLLOID CYSTIC NODULE ONLY 5 CC BROWN FLUID REMOVED. THE REST WAS TOO THICK TO EVACUATE.
0.3 CC CYST FLUID REMOVED 0.2 CC 98 % DEHYDRATED ETHANOL INJECTED. THE PLAN WAS TO ALLOW THE SMALL AMOUNT OF ETHANOL TO LIQUIFY THE THICK CYST CONTENTS AND THEN DO A 2 STEP PEI IN A FEW WEEKS TO COMPLETE THE THERAPY.
ETHANOL INDUCED THYROIDITIS
SHE DEVELOPED CHILLS, FELT FEVERISH, SORE THROAT, PAIN WITH YAWNING AND SNEEZING RADIATING TOWARD THE EAR. THE NODULE WAS ENLARGED AND TENDER. TSH WAS LOW 0.13 SED RATE HIGH 87 ULTRASOUND: CYST ENLARGED TO 11.5 ML Treated with prednisone 10 mgs bid for 3 weeks.
A RARE COMPLICATION OF PEI FOR RECURRENT BENIGN CYSTS OCCURRED WITH SWELLING AND PAIN NEEDING TREATMENT WITH PREDNISONE. THE THYROIDITIS RESOLVED BY 4 WEEKS, AND 6 WEEKS AFTER A MINUTE AMOUNT OF ETHANOL 0.2 CC, THE CYST WAS DRAMATICALLY SMALLER 0.66 ml. USUALLY 50% OF THE VOLUME OF THE CYST IS INJECTED AS ETHANOL. THIS SMALL AMOUNT OF ETHANOL NOT ONLY CAUSED THE THYROIDITIS, BUT ALSO CURED THE CYST.
RESIDUAL SMALL REMNANT 0.66ML OF THE 8 ML CYST AFTER MINIMAL ETHANOL INJECTED INTO A THICK FLUID CYST CAUSING A PAINFUL THYROIDITIS AND FINAL ABLATION OF THE LARGE CYST.